Prehospital command hierarchy, fitting it in with the regular medical community

[Katy]

Well, I don't know where you work but I'm sorry you have such a low opinion of EMS. Half of the students in my class have bachelors and 75% have associates. Some of them have degrees in biology and other medical related sciences. EVERYONE in my class has taken college level A&P I & II, Psychology, and Microbiology. Plus almost everyone has been on the street as EMT's for a minimum of 1 year most have several years of experience. I'm not sure how you are equating all of this school and experience as undereducated.....Don't take one apple out a barrel and call the whole barrel bad

Maybe because the fact that such programs exist? And a good amount at that.

 

[ZootownMedic]

I'm not sure they surpass the LPN's in that area either.

Maybe I don't know to be honest with you, all I can go on is my limited knowledge. I do know that EMT's where I work can start intravenous lines, perform assessments of OB, Geriatric, and Pediatric patients, as well as several other invasive procedures all on standing orders and without supervision. Again, not necessarily saying surpass, but probably equal. Now I don't argue that a LPN has significantly more understanding of A&P, patient care(esp longterm) and pathophys than the average EMT.

 

[Katy]

Maybe I don't know to be honest with you, all I can go on is my limited knowledge. I do know that EMT's where I work can start intravenous lines, perform assessments of OB, Geriatric, and Pediatric patients, as well as several other invasive procedures all on standing orders and without supervision. Again, not necessarily saying surpass, but probably equal. Now I don't argue that a LPN has significantly more understanding of A&P, patient care(esp longterm) and pathophys than the average EMT.

I'm pretty sure in the state of Colorado the EMT-B must be I.V. certified to do some of those things. If the LPN is certified, he/she can do all of the above and I bet more. And LPN's can assess patients, and are especially trained in focused and initial ones. Most of the time they are checked off or signed by the RN. Correct me if I am wrong though.

 

[ZootownMedic]

Maybe because the fact that such programs exist? And a good amount at that.

I know that my school produces outstanding medics, has a 100% first time pass rate on NREMT, and have the respect of patients, ER docs, and peers when working the streets.

 

[Katy]

I know that my school produces outstanding medics, has a 100% first time pass rate on NREMT, and have the respect of patients, ER docs, and peers when working the streets.

Like you said earlier, you can't take an apple out of the barrel and judge the whole barrel based on that one. Your program is what we strive for, but sadly they aren't a standard practice.

 

[JPINFV]

Well, I don't know where you work but I'm sorry you have such a low opinion of EMS. Half of the students in my class have bachelors and 75% have associates. Some of them have degrees in biology and other medical related sciences. EVERYONE in my class has taken college level A&P I & II, Psychology, and Microbiology. Plus almost everyone has been on the street as EMT's for a minimum of 1 year most have several years of experience. I'm not sure how you are equating all of this school and experience as undereducated.....Don't take one apple out a barrel and call the whole barrel bad

That's great (even though I personally don't care about the year of experience bandaid fix to limited time). However, there are plenty of schools in California that turn out paramedics at the minimum 1000 hours without any serious pre-reqs (oh, wait, a 4-5 day A/P for Paramedics program).

One bad apple spoils the bunch. The problem with EMS is that it isn't just one bad apple.

 

[ZootownMedic]

If the nurse has an issue with nursing care, in contrast to medical care, they aren't going to call the physician for orders. Additionally, they aren't going to call just because they're scared about liability. Personally, I think the "I'm not sure if the patient who's A/Ox4 and has capacity can sign AMA, so I'm going to call medical control just in case, and that way the liability is on them" type of call is nothing more than a -false- sense of security.

I don't want to have physicians riding on every ambulance. I want the people who are providing care on an ambulance to be able to have the foundation to make decisions and justify those decisions without using medical control as a "I'm scared of the dark, and medical control is my blanky."

Furthermore, it's not even appropraite to compare a nurse calling for orders to a paramedic. The ward nurse more often than not is calling the patient's personal physician, who personally knows the patient, has examined the patient, and knows what the patient's current treatment plan is and why, where the medical control physician only knows what the paramedic thinks is important to tell him.

Oh, and if EMTs aren't professionals, then they need not be on an ambulance without direct supervision. If paramedics are a profession, then they, as a whole, need to start acting like it, including demanding a proper education.

Your being a little dramatic don't you think? I mean who calls a doc to see if a pt is AA0X4? Thats what a mental assessment is for. And you are saying that using Med Control is a crutch but that is the exception not the rule....most medics use Med Control for what its for....to obtain orders that exceed protocols and/or to get a higher and more educated opinion when the situation requires it. Rarely is it used to 'just get the load off my back' as you are implying....

 

[usafmedic45]

I know that my school produces outstanding medics, has a 100% first time pass rate on NREMT, and have the respect of patients, ER docs, and peers when working the streets.

Google the phrases "statistical outlier" and "anecdotal evidence".

 

[ZootownMedic]

That's great (even though I personally don't care about the year of experience bandaid fix to limited time). However, there are plenty of schools in California that turn out paramedics at the minimum 1000 hours without any serious pre-reqs (oh, wait, a 4-5 day A/P for Paramedics program).

One bad apple spoils the bunch. The problem with EMS is that it isn't just one bad apple.

WOW...you have a really low opinion of EMS. Whats your experience? Im seriously curious...one state? Since California does EVERYTHING right :rofl:
And give me a break with the more than one bad apple.....your saying that there is a such a higher ratio of bad medics to good ones compared to say bad nurses or doctors to good ones? Show me some statistics or evidence other than your limited opinion?

 

[ZootownMedic]

Like you said earlier, you can't take an apple out of the barrel and judge the whole barrel based on that one. Your program is what we strive for, but sadly they aren't a standard practice.

Your point is valid, I just don't think it's quite as bad as people are making it out to be. You do still have to pass NREMT. Granted its just a test but it does say something.......

 

[ZootownMedic]

Google the phrases "statistical outlier" and "anecdotal evidence".

Don't need too....the fact that my school has a 100% pass rate is a fact not hearsay. Don't know why the negativity is so strong...........

 

[Katy]

Your point is valid, I just don't think it's quite as bad as people are making it out to be. You do still have to pass NREMT. Granted its just a test but it does say something.......

Also granted that the majority of Paramedics who had a halfway decent program and actually learned stuff thought it was relatively easy. Most people consider the NREMT a "joke" in regards to its difficulty.

 

[ZootownMedic]

Also granted that the majority of Paramedics who had a halfway decent program and actually learned stuff thought it was relatively easy. Most people consider the NREMT a "joke" in regards to its difficulty.

Haha true.....All I can do is work hard everyday to be the best Medic I can be. I hope if I run into any of these EMS 'haters'(on this EMS board btw) I can prove them wrong and show them what a good Medic is all about. I am a little surprised that current Paramedics haven't joined in this conversation.

 

[Katy]

Haha true.....All I can do is work hard everyday to be the best Medic I can be. I hope if I run into any of these EMS 'haters'(on this EMS board btw) I can prove them wrong and show them what a good Medic is all about. I am a little surprised that current Paramedics haven't joined in this conversation.

I wouldn't consider them haters, you may sometimes see them as "harsh" because they are being critical of a career they care about. Tough love.

 

[ZootownMedic]

Citation please, the Rule 500 that I read from states that basics can push frontline cardiac meds during an arrest only, and nothing else.

I will see if I can find it. And you may be right about frontline cardiac meds but as far as I know for most meds(maybe cardiac ones as well) if the Paramedic tells them to push it then they can. Again, you may be right.


Are there any reasons in favor of EMS not interacting with a physician more? I mean honestly it can only lead to the betterment of EMS given that we need the MD's help to advance. In order for MDs to really trust their EMS providers (and I know it does happen, just not where I am), we are going to have you know, actually talk to the doctor now and then.

Also think twice about RNs only being able to implement procedures and interventions or asses a patient without an MDs orders. I've seen and been a part of codes worked at Penrose in C Springs where the ED physician was not present for any length of time. Everything went smoothly with only a few RNs, Techs, and RRT. A

ER RN's are another breed. Truly professionals and I have been impressed with almost all that I have met. One of the ER RN's at Penrose is a mentor of mine and if I could be half the Emergency Medical clinician that he is I would be immensely proud.

 

[ZootownMedic]

I wouldn't consider them haters, you may sometimes see them as "harsh" because they are being critical of a career they care about. Tough love.

Eh...I'm feeling a lot more hate than love or constructive criticism. And none of them are Paramedics so I don't really understand where their expertise is coming from other than observations in their limited area. It'd be like running into a couple burnt out RT's, Nurses or Doc's and saying that most Doc's, Nurses or RT's in the country don't know what they are doing. Pretty thin

 

[silver]

WOW...you have a really low opinion of EMS. Whats your experience? Im seriously curious...one state? Since California does EVERYTHING right :rofl:
And give me a break with the more than one bad apple.....your saying that there is a such a higher ratio of bad medics to good ones compared to say bad nurses or doctors to good ones? Show me some statistics or evidence other than your limited opinion?

 

[Katy]

RN's that are not really part of emergency medicine or a similar discipline aren't even close to Medics in their freedom, medical skills, or judgement making abilities.

Honestly, this is hard for me to believe. What about a good ICU nurse? Or a nurse working in a Pediatric floor? These RN's must have good judgement making skills and medical skills.

 

[ZootownMedic]

Well played....and interesting if not weird<_<

 

[ZootownMedic]

Honestly, this is hard for me to believe. What about a good ICU nurse? Or a nurse working in a Pediatric floor? These RN's must have good judgement making skills and medical skills.

I don't know, maybe I have to eat some humble pie because of my foot in mouth. I'm sure they have OUTSTANDING judgement making and medical skills....they still get direct orders from a doc on their floor........